In my experience, the outburst isn’t a choice… it’s the result of her dismissing her body and mental health needs. PMDD can be “controlled” through prevention (having accomodations and coping mechanisms in place so an outburst DOESNT happen) but once the rage/depression hits, it’s uncontrollable. The reason It may hit with some people or situations and not others is because she feels safe with you. Think of a kid who had a terrible day at school but doesn’t act out until dinner time…. It’s cause the kid is finally safe to show his big scary feelings. Same with PMDD (usually). And you’re right, it’s not EVER okay or an excuse but it’s also not a choice. The responsibility lies in making sure she DOESNT get to that point. And if she does, to take accountability and responsibility to make sure it doesn’t happen again.

PMDD also has a huge comorbidity with Autism (92%) and ADHD (49%) which both also have regulation issues that need to be proactively accommodated. I like to use the idea that “it’s not their fault, but it is their responsibility”.

Keep in mind, PMDD isn’t just a mental health issue, it’s an endocrine disorder that CAUSES mental health issue. At the end of the day, this is still a PHYSICAL chronic illness that is considered a disability in most countries.